Why exercise makes sense
When you're in pain, the last thing you may want to do is exercise.
But people with conditions like rheumatoid arthritis are more likely to keep symptoms under control if they exercise at least a little bit every day, says Andrew McDonnell, supervisor of outpatient physical therapy at Scott & White Sports Medicine & Rehabilitation Clinic in Round Rock, Texas. Exercising also helps the heart, lungs and brain.
Always consult a physical therapist before starting an exercise regimen so you don’t do anything that worsens pain. Here are 14 types of exercise that may help you move and feel better.
Slow it down
If you’re in the middle of a painful flare, you definitely don’t want to do anything that’s going to increase the inflammation.
Generally, experts recommend that you continue any exercises you can, perhaps substituting range of motion and stretching for more rigorous strengthening. Or you could concentrate on an area of your body that isn’t having the flare.
In some cases, “it is appropriate for the person to discontinue exercises for a short period of time,” says McDonnell. But not for long as this may become a vicious cycle, leading to stiff, weak joints.
If your joints are aching, taking to the water may be the way to go. “The buoyancy takes weight off of the joints,” explains McDonnell.
Swimming is also good for the upper extremities, helping to keep the elbows flexible. Water exercises could take the form of regular lap-lengths, water aerobics, or just walking in the pool.
A 2012 study found that aquatic exercises conferred small-to-moderate benefit on various forms of pain, including low back pain, osteoarthritis, fibromyalgia, and rheumatoid arthritis.
Whether it’s a stationary bike in your living room or a ride outdoors, biking provides not only weight-bearing benefit, but can also release the feel-good hormones known as endorphins.
People with arthritis of the knees may have some difficulty with biking, says McDonnell, so make sure the seat is at the right height. In this situation, a recumbent bike might be your best bet.
“It’s good because the seats are anatomic and help support the spine,” says Robert Irwin, MD, associate professor of clinical rehabilitation medicine at the University of Miami Miller School of Medicine.
Weight lifting can be useful for people in pain, including those with rheumatoid arthritis, but such a program needs to be practiced in moderation,” says Dr. Irwin.
Don’t think of weight-lifting as something that can turn you from a 90-pound weakling into the Incredible Hulk. Instead, think of it as taking a daily vitamin.
“When we were younger, we wanted to look good in a bathing suit or have big biceps,” says McDonnell. “As we get older we have to look at exercise as a kind of medicine.”
Walking can be difficult if you have foot and knee symptoms, but if you can do it, this type of exercise can strengthen the muscles around the knee, which actually helps protect the joint.
“If the thigh muscles or the quadriceps are in good condition, shock in the legs gets deflected away from the knee,” McDonnell says. “If the muscle is in poor condition, it can’t absorb the shock and it gets transmitted to the joint and causes inflammation.”
But just walking from your car to the front door may not be enough to reap the benefits of this particular exercise, as you’re unlikely to get any cardiovascular benefit.
Trace the alphabet with your feet
According to the American Academy of Orthopaedic Surgeons, 90% of people with RA will have symptoms in the foot and ankle.
Needless to say, this can make many forms of exercise difficult. McDonnell shows his clients how to trace the alphabet in the air with their foot. Start with an “A” then a “B” and use your whole foot, not just your big toe.
This will help preserve range of motion in the ankle which helps maintain function in the joints and reduces pain by relieving stiffness. “It also helps maximize nutrition to and lubrication to the joint,” says McDonnell.
Squeeze your hands
Maintaining range of motion is just as important in your hands. More motion means that stress is distributed over a wider percentage of the joint cartilage, ensuring that one area won’t be unduly burdened, says McDonnell.
Simply squeezing your hand, opening and closing it or touching the tip of each finger then sliding it down to the base of the same finger can maximize range of motion and perhaps make simple everyday tasks like opening a jar easier.
More than one study now points to the effectiveness of this ancient Chinese martial art in improving arthritis pain.
One, in the prestigious New England Journal of Medicine, found reductions in pain, stiffness, and fatigue in a group of 33 fibromyalgia patients who practiced Tai Chi twice a week for two weeks.
Tai Chi harnesses both the mind and the body and can help build strength and endurance. What’s more, it can easily be practiced at home, in a class, or in the park.
This fitness system was developed by Joseph Pilates more than 100 years ago to build strength in the abdomen and back.
Not only is it strengthening, says Dr. Irwin, it also promotes balance, perhaps enough to decrease the risk of falling and sustaining a fracture.
Pilates has been shown to help people with low back pain as well as fibromyalgia.
A study conducted in the U.K. found that both resistance training and cardiovascular exercise not only reduced the severity of rheumatoid arthritis in a group of 40 adults, it also improved cardiovascular fitness.
This is important because people with rheumatoid arthritis have a higher risk of both heart attack and stroke.
But, again, the key is moderation. A physical therapist or occupational therapist will be able to advise you with respect to particular resistance exercises, sets, and repetitions.
Like Pilates, yoga can improve strength and balance, and possibly reduce harmful falls.
One recent study found that nine weeks of yoga provided relief for people with chronic neck pain. Another study found that "Yoga of Awareness," which focuses partly on awareness and breathing, relieved pain in fibromyalgia patients, with more being better.
But don’t overextend yourself. “A person who’s doing this should pay attention to what their body is telling them,” says Dr. Irwin. “They shouldn’t push themselves in these situations.”
Keep a ball of Theraputty ($18; amazon.com)it looks like Play-Doh for adultson your desk or table. Pinching, rolling, squeezing, and generally having fun with it will keep the hand and wrist joints limber and the muscles and tendons strong, says McDonnell.
Another helpful exercise is placing a rubber band around the thumb and fingertips and spreading the thumb and fingers as much as possible against the resistance of the rubber band.
Pinching clothespins will help maintain and increase pinch strength which is important in maximizing the functional ability of the hand, says McDonnell.
Stretching can be a simple, any-time exercise that won’t load the joints.
Stretching programs abound, including one with pictures and instructions from The University of California, Los Angeles.
As with all exercise programs, practice caution when starting something new.
Squats can be good for the knees but, if performed too intensely, can also cause pain and even damage.
If you’re not up to full squats (how many of us are?), try partial squats, advises McDonnell. Stand with your feet shoulder-width apart and pointed straight ahead. Slowly squat until you’re at about a 45-degree angle, bending at the knees but making sure the knees do not extend forward beyond the toes.
To help keep your balance, try the partial squat while leaning your back against a wall (partial wall squat).
Running and jogging
High-impact activities like running and jogging can be hard on the joints for anyone, not just those suffering from chronic pain.
If you and your doctor or physical therapist decide this is an appropriate exercise for you, limit your stress on the joints by using “Bare Foot” sports shoes, the ones that have five toes like a glove, says Dr. Irwin. “You sort of glide over things,” he says. “They are much safer on the knees and other joints.”
The good thing about aerobic activities like running, biking, and swimming is that they will, over time, increase blood flow throughout the body. This decreases cytokines, molecules that exacerbate inflammation, says Dr. Irwin.